Healthcare Provider Details

I. General information

NPI: 1629497144
Provider Name (Legal Business Name): WAI PHYU ZAW M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2014
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CLOVE ROAD
STATEN ISLAND NY
10301
US

IV. Provider business mailing address

55 WATER STREET FL 2ND FLOOR CRED DEPT
NEW YORK NY
10041-0004
US

V. Phone/Fax

Practice location:
  • Phone: 718-816-6440
  • Fax: 718-816-3611
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number295897
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: